


Psych Evaluations

by EarthToKit



Category: Star Trek: The Original Series
Genre: ADHD, Autism Spectrum, Autistic Spock, Basically if you think diagnostic manuals are kind of interesting, Character Study, Dysthymic spock, Gen, Headaches & Migraines, Hurt!Bones, POV Original Character, PTSD Kirk, Post-Traumatic Stress Disorder - PTSD, Psychologists & Psychiatrists, Psychology, Stress reactions in general, adhd kirk, and/or you like to headcanon people as neurodivergent, diagnostic manuals of the future, etc - Freeform, exposition en masse, interesting sensory differences Bones, kind of, lesbian character (OC), psychiatry, psychotic character (OC), sensory processing, the triumvirate's psych evaluations for your viewing pleasure, this is probably the fic for you, well kind of the diagnoses differ somewhat but if i were to express it in current terms
Language: English
Status: Completed
Published: 2017-11-16
Updated: 2017-11-16
Packaged: 2019-02-03 09:53:59
Rating: General Audiences
Warnings: No Archive Warnings Apply
Chapters: 1
Words: 6,069
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/12745971
Author URL: https://archiveofourown.org/users/EarthToKit/pseuds/EarthToKit
Summary: Maria Nakashima is a psychiatrist tasked with making a psychological evaluation of all souls aboard the enterprise. It's late, her head is buzzing, and she's going over her most recent reports on the top officers instead of sleeping.Bones just wants that sweet, sweet pain relief......Or the one in which I invent a new diagnostic system and go to town on the triumvirate.





	Psych Evaluations

**Author's Note:**

  * For [AlyssiaInWonderland](https://archiveofourown.org/users/AlyssiaInWonderland/gifts).



> This is a fairly nerdy story. It was borne out of a conversation with AlyssaInWonderland about the possible neurodivergence of the whole crew, which is why I’m gifting it to her. Credit where credit is due! They were the one who came up with the idea for Bones’ particular symptoms, and as a matter of fact she’s writing a fic featuring some of that right at this moment! Their stories are pretty fucking awesome, so ya’all should go check her out ^^  
> Anyways, the question this story grapples with, beyond “are any of the senior officers neurodivergent?” is “How will the diagnostic manual look so many years into the future?”. In the approach I’ve taken, the journal is more specific and includes some things that may not be seen as disorder today. To counter this, they no longer call it disorder, but divergence, and a diagnosis is a designation. It does not necessitate clinical distress. A few more thoughts on the psychiatric world-building in the end comments.  
> As someone who knows the diagnostic manuals from two sides (I study psychology, and I am diagnosed with mental illness and neurodivergency), it was quite fun to play around with a Future Manual <3  
> In the end I only got around to doing the “main three”, Bones, Jim and Spock. I simply grew weary of the format. Maybe I’ll return with a follow-up on some of the other characters eventually!  
> I had a suspicious lack of psychotic headcanons for someone who is psychotic, which is why the psychiatrist ended up with PsD (Psychotic Divergence).  
> Without further ado… Enjoy!

 

The yearly psychiatric check-up was all but a formality, though an expensive and time-consuming one at that. It was generally agreed upon, that the Crew and Senior members of a starship proved their capability through their missions, and so Maria had not been expecting to be disqualifying anyone. In any case, the rights of divergent members of Starfleet were numerous, and it was very rare for an updated designation to lead to anyone’s departure from the fleet.

Still, Maria Nakashima had hoped to be able to give a few recommendations for accommodations that would make life easier for divergent crew members.

While there was a psychiatric and psychological care unit on board, the yearly check-up was done by an outsider to the ship, and indeed to the fleet as a whole. Maria usually worked in an inpatient care facility on earth, primarily focused on psychotic and mood divergence, and the intersection of the two. She’d gotten the call to assist with the yearly check-up a few months in advance, and at first she hadn’t known quite what to feel.

It required her to travel with the crew for some months. Even doing several interviews a day, there was no getting around the fact that the Enterprise had over 400 souls aboard.

Her colleagues had urged her to decline the invitation, on the grounds that she would end up in potentially dangerous situations – and think about your divergence! -, and that even if the compensation was good, it just wasn’t worth it. But her wife had simply looked at her knowingly, while dreams long forgotten bubbled to the surface of Maria’s mind under Joan’s loving and non-judgemental gaze.

The stars. There was a time where she’d dreamt of being a ship’s doctor. Long before she’d found her call with those souls most disturbed by the divergence that marred her own life, she’d thought she’d be the emotional rock in a bottomless sea of stars, exploring the farthest reaches of the galaxy.

Maria had accepted the appointment the very next day.

Now, downing her third cup of synthesised coffee, seated under the artificial light of medbay, pouring over the files of those she had interviewed, the whole thing didn’t seem quite so magical anymore. She missed her wife and their dogs, and the long-term patients who would always greet her in the morning. And the sun. Fuck, if she didn’t miss the sun.

It wasn’t like she ever got to go with the crew to any planet’s surface, and she could hardly count the times they’d all been held captive to some strange enemy. The first times she’d been shaken to her core, but now it seemed like just another day on the ship. It made her think about the resilience necessary in those choosing to spend their life in such an environment.

“ _You wouldn’t have lasted even a year_ ,” a voice snarked, but Maria didn’t pay attention to it.

She put the padd down for a moment, and stretched her hands above her head. There was more divergence aboard the ship than one might initially expect, even divergence that would formerly have been classified as disorder, that was to say, a cause of significant clinical distress. Even then, the psychiatric care unit of the Enterprise was doing a terrific job, and the whole ship worked together like a well-oiled machine.

Maria had started from the bottom, working her way up through the ranks, and it was only recently that she had assessed the Senior Officers. For better or worse, this meant her job upon the ship was done, and she would be dropped off once they reached Earth. She figured that she had better finalize the reports before landing, while they were still fresh in her memory.

She pulled the padd back to her. It was displaying the newest added file, that of James T. Kirk, the Captain of the ship. It was honestly a shame that she only had about two hours with each crewmember, it hardly made for a proper diagnostic interview. Then again, Maria was simply doing a follow-up, and confirming the findings of the on-board psych team. Thankfully she wasn’t the only one working on the evaluations, two psychiatric nurses had been brought aboard as well. They’d prepared each interviewee by isolating potential areas of divergence, and administering questionnaires for the computer to chew on.

All this had meant Maria had been rather thoroughly prepared for each encounter. She returned her attention to the Captain’s file. A remarkable man, in his own right, and not an uninteresting psychological study.

 

 ____________________________________________________________________________

 

## Captain James Tiberius Kirk

### Description

Kirk functions well in his role as captain, and is well-respected among the crew. He describes several of his fellow senior officers as close friends. He appears to take risks of some magnitude, especially where his own life is concerned, but throughout the interview and my observation he does not appear to have suicidal tendencies, merely a disregard for his own safety. Considering the nature of the ship’s mission, I believe that his behaviour is within normal range for the Captain of a vessel.

Kirk is often impulsive, but this does not appear to impede his ability to command the vessel, as it means he is also decisive and quick to act when the situation calls for it. Kirk was diagnosed with ND- ADD+IHD at age 9, and takes medication to counteract his hyperactivity and to improve his focus. He still complains about some issues with self-management, esp. concerning sleeping and eating at regular intervals, and indicates that his focus gets worse when these basic needs are not met. On the other hand he seems to have an ability to focus excessively on a task that needs to be done, effectively engaging in hyper-focus. This seems to work in favour of the ship.

Kirk indicates that he still feels the need to fidget, and does so occasionally.

All in all I am in agreement with the Neurodevelopmental Divergence designations of ADD and IHD.

Kirk expresses some symptoms of Mood Divergence of the Melancholic designation, but I suspect that these symptoms of MD stem from Reactive Divergence.

Kirk has earlier indicated traumatic experiences in his youth on Tarsus IV, indicating that he is occasionally reminded of this and experience flashbacks that have grown milder over the years. In my assessment he also speaks of guilt with regards to crewmembers he have lost, including a close friend. He refuses to elaborate on the death of this Gary Mitchell, but records indicate that he died in the line of duty. Kirk does not show avoidant behaviour to a point where it appears detrimental to his function as Captain of the ship.

### Test results

Focus – Low but within normal range (subject on exepharon)

Traumatic Reactions – Medium range. High scores on reliving and guilt.

Personality – non-divergent

Mood Questionnaire – Moderately high score on Executive Dysfunction, Moderately high score on guilt.

### Designation

ND (Neurodevelopmental Divergence) – ADD (Attention Deficit Difference) + IHD (Impulsive Hyperactive Difference)

RD (Reactive Divergence) -  TER (Traumatic Exposure Reaction)  + TIGR (Trauma Induced Guilt Reaction)

### Reccomendations

It is my recommendation that Kirk continue on exepharon on his current dose for AD. I suggest attempting to lower the dose of Anaphlasm for IH as he doesn’t complain overly about hyperactivity, and indeed, his impulsiveness, has often saved the ship.

I highly recommend a program of targeted therapy regarding the feelings of guilt in the subject. I would not recommend psychotropic medication for these problems, unless his mood worsens significantly.

**Fit for duty:**

Yes

 ____________________________________________________________________________________

 

 

Maria put the file down. It seemed… fine. She was going back and forth on her recommendation regarding the Anaphlasm. After all, the Captain was functioning optimally as was, so why fix something that wasn’t broken? On the other hand, his records indicated that his dose had been almost unchanged all the way through adulthood, and Maria had her misgivings about the use of Anaphlasm in the first place. It was widely discussed whether it actually had any effect on impulsive behaviour, while it certainly had an effect on hyperactivity with regards to fidgeting and excessive talking. It was a widely used medicine for those who were Neurodevelopmentally Divergent, but Maria sometimes felt like it was intended to suppress natural behavior so people wouldn’t be a “bother”, rather than to actually help them feel better.

Then, Maria had it on paper, that she had a tendency towards paranoia. Maybe she was overthinking this. ND’s weren’t even her field of expertise, and Kirk had seemed happy enough with his prescriptions.

Maria let her eyes glance over the page once again. While most psychological journals were included in the Health Privacy Act, the documents she was preparing were essentially open game to the higher ups in Star Fleet. She didn’t really like this idea that unrelated people would be reading about her… well, they weren’t her patients. But still. She didn’t like it.

She looked on the page for a while longer.

“Computer,” she said, and the computer at the table turned itself on. “Display file of James Tiberius Kirk.”

She put the padd down, and quickly changed the entry, so it didn’t mention the incident with Gary Mitchell. It had seemed like Kirk didn’t particularly care to elaborate, and somewhat to her own surprise, Maria found herself trusting the man. If he didn’t want the higher-ups to know any more about the circumstances of his death, she would neglect to bring the issue to their attention. It wasn’t like she was actually Star Fleet personell.

“You should sleep,” she said to herself. It was true. She had had too much coffee, and there was a steady buzzing in her head. It sounded suspiciously like the old-style fridge in her parent’s home. Yet she wasn’t very much inclined to go to bed.

Her quarters on the enterprise were exactly to regulation, but they were empty and lonely, and she would wake up drenched in sweat from nightmares and everything would be so LOUD and she would be alone, and no one would be there to hold her while she rocked herself back to sleep.

No. Maria didn’t much care to sleep upon the Enterprise.

She recognized she’d lost a moment, when she came back to herself, shivering in her chair, clutching the padd closely to herself. What had she been thinking of?

Oh right. Captain Kirk. The only thing she’d changed from previous assessments was adding Trauma induced Guilt to his list of designations. It was merely a designation under Reactive Divergence which he was already categorized with, so her assessment hadn’t changed much in his overall profile. It would be fine.

“Now, this is slightly more controversial..” she muttered to herself, as she pulled up the next file. That of First Officer Spock.  She had been somewhat reluctant to interview the half-Vulcan. It was unclear whether applying human concepts of Divergence to an alien, even if half-human, was ethically recommendable.

On the other hand, the hybrid deserved accommodations much in the same way that the rest of the crew did, and besides, the yearly evaluation was required. Usually aliens would be assessed by their culture’s equivalent of a psychiatrist, and possibly by a human psychiatrist, but they could choose to opt out of that. However, Spock was half-human, and so Star Fleet believed that he ought to be assessed both as a human and as a Vulcan.

Maria had been frankly.. perplexed by the files she had read in preparation for her interview with Spock. And boy, had she read a lot, because if one assessment had been worrying her from the beginning, it had been that one.

The Vulcan healers and the human doctors seemed to have a completely different take on the man. His Vulcan records dated back to his childhood and described an “odd and emotionally disturbed child”, who had been slow to speak. She wasn’t so sure about the things relating to Vulcan psychic bonds, but as far as she understood, he had been slow to establish these, and once he did, he exhibited “disturbing emotionalism” through them. Spock had been prescribed meditation and been taught to build walls and suppress his emotions. Newer assessments from Vulcan healers showed Spock to be resistant to the mind probe and to still harbour some disturbing emotionalism, yet they marked his behaviour as unremarkable and noted that they considered the fact that he didn’t act on this emotionalism a sign of mental health, and that his emotionalism was to be expected from someone who was half human.

Quite to the contrary, the human doctors who has assessed Spock throughout time, had remarked that he was aloof and distant and didn’t seem to have much in the way of emotion or empathy. Each doctor seemed to have a different approach to his designation, and Maria had been dizzy reading through the different reports.

Almost everyone had suggested Personality Divergence, usually of the schizoid type. Some had postulated a rare Reactive Divergence as a result of a “human” child being raised in a Vulcan culture. Many reports indicated a Mood Divergence of some kind. And of course there were more than a few Neurodevelopmental Divergence designations, particularly relating to social interactions.

Maria bit her lip as she stared down at her own report. Who was she to say that hers was any better than the ones that had come before her? It didn’t help that there was a clear discrepancy between how Spock saw himself and wanted to be seen and his actual disposition. Two hours was simply not enough to get much beyond the surface. Yet she had found that while he didn’t bring any issues up on his own, he wasn’t prepared to lie directly about it when asked. And Maria had done her homework, observing interactions on the bridge and among the crew, so she felt like she had eventually coaxed a fairly coherent picture out of him.

She yawned, and put the padd back on the table. Maybe she should go to her quarters and attempt to sleep anyways.

“ _You’re useless. Can’t even go to bed at a decent hour. Making yourself sicker. How fucking dumb are you_?” Maria straightened her hair nervously. To be fair, the voice had a point. She had kind of lost her center since coming aboard the enterprise, and losing her support system. At the same time, the constant stress of life or death situations, coupled with the gruelling pace of her assessment work, had left its marks on her psyche.

The buzzing was growing louder. Maria closed her eyes.

“In just a few days you’ll be home,” she muttered. “This is not the time for a fucking breakdown.”

“ _You’ll be dead before you’ll ever see Joan again_.”

Maria opened her eyes and stared determinedly at the padd.

“First Officer and Science Officer S'chn T'gai Spock,” she read out loud, stumbling a little over the odd name. “Now you read this like a good little girl, and then you go the fuck to sleep, m’kay?” she said to herself.

“M’kay.” She agreed with herself, and picked up the padd so she wouldn’t be reading from such an awkward angle.

 

 _________________________________________________________________________

## First Officer and Science Officer S'chn T'gai Spock

 

### Description

Spock presents with a somewhat curious psychological profile, perhaps owing to his dual heritage. He is intellectualizing and somewhat guarded in his responses.

When directly questioned he indicates life-long difficulties understanding and responding to emotion in himself and others. This might be a result of being taught to suppress his emotions from a young age, but in my professional opinion it goes beyond that and could be a sign of ND. In my observations he appears to have difficulties with figurative language as well, a characteristic not shared by most Vulcans, which again leads me to think ND. His productive language appears stilted and over-elaborate. Overall, he seems to have a hard time relating to others, and mask this by way of somewhat aloof behaviour. Despite this he seems to have meaningful relationships with other members of the senior crew.

I believe there is substantial evidence that these difficulties in relating to others have been static since early childhood, and therefore find that they are more likely to be accounted for by neurodevelopmental divergence than personality divergence, which usually manifests later.

On suspicion of an autistic constellation, I have asked the subject about commonly co-occuring designations. He indicates a preference of routine, and reflects that his interests are few but intense. He appears somewhat unwilling to discuss SID, but he does indicate a dislike for bright light and loud sounds, as well as other classically occurring difficulties. He does not appear to engage in self-stimulatory behaviour, and rather comes across as rigid and controlled. He admits to feeling the urge, but having been taught since childhood that such behaviour was not acceptable for a Vulcan.

He exhibits some sign of Mood Divergence as can be seen in the test results but not enough to warrant Major MD. I have decided to classify these as they are unaccounted for by other designations in his profile.

He exhibits some signs of prolonged stress, such as an unstable self-image, fragile self-esteem, denial and self-blame. He does not present with flashbacks, and his reactivity seems to be emotional and cognitive in nature and not based on a single traumatic event. This is probably due to the stress associated with not belonging entirely to a specific group, the stress of being taught to conform to a culture foreign to his emotions, and the social ostracizing he has faced over the years. He appears to explain these experiences as consequences of personal shortcoming.

Subject appears relatively well-adjusted in his current position, and I note that he has significantly better mood scores than at last year’s assessment.

 

### Test Results

Social Pragmatism – low, indicative of fairly severe difficulties.

Personality Divergence Questionnaire: Moderately high scores on schizoid + obsessive compulsive + Distant Aloof

Mood Questionnaire: High scores on melancholy and anhedonia. Otherwise within normal range.

Traumatic Reactions – Medium range. High scores on self-image, denial and blame. Low scores on reliving.

 

### Designation

ND (Neurodevelopmental Divergence) – SPD (Social Pragmatic Difference) +RR (Repetitive /Restricted Difference) + SID (Sensory Integretative Difference). [A cluster of these symptoms is often referred to as ND – AC (Autistic Constellation).]

RD (Reactive Divergence) – PNER (Prolonged Negative Exposure Reaction)

MD (Mood Divergence) – AT (Anhedonic Type) + MT (Melancholic type). Not enough to qualify for MMD (Major Mood Divergence)

NOTE 1: I believe the former categorization of PD (Personality Divergence) to be in error, as the symptoms seem better accounted for by a combination of ND, RD and MD, not to mention the culture of the subject. While he does score high on schizoid, I believe this result to reflect the subject’s self-image rather than his actual state.

NOTE 2: I find it prudent to stress, that my observations are based on human standards of normalcy, and as such there is a limit to their scientific accuracy in describing the subject’s possible divergence.

 

### Reccommendation

It is somewhat unlikely that Spock will benefit from talk therapy, as he has expressed a distaste for this practice, yet I cannot in good conscience not recommend therapeutic intervention. It is possible that he would benefit from emotion focused therapy, while cognitive therapy is likely to encourage his tendency to intellectualize. It may, however, be useful as a means to finding alternative interpretations of detrimental beliefs about logic. Self-acceptance therapy might be useful here, as the subject appears to be at odds with himself. I would leave the specifics of the therapy up to a psychologist.

I have encouraged the subject to engage in healthy stims, though he insists such an urge is illogical, and I have suggested ways in which he may deal with sensory and emotional overload in less detrimental ways. He might want to work with a Sensory Specialist to address these concerns.

Had the subject been human, I’d recommend a low dose of Qirofax to improve his mood, but it is unclear how such drugs will interact with his half-Vulcan biology, and the subject doesn’t seem particularly interested in intervention.

 

### Fit for duty:

Yes.

 

_______________________________________________________________________________

 

 

Maria didn’t want to look up from the padd. She had a feeling that she wasn’t alone. It was ridiculous, as the clock at the top of the screen on the padd told her it was half past 2 in the night on the internal ship’s time. No one was going to come to med bay at this hour, unless there was some kind of emergency. Was there some kind of emergency?

She finally looked up from the padd. No one was there. Of course they weren’t, she would have heard them coming. Never the less.

The problem with having a high psi-score, while at the same time being Psychotic Divergent, was that you never knew whether to trust your hunches. She shrugged, and put the padd on the table. Time to go the fuck to bed. She felt like she still needed to improve Spock’s report, but it also felt quite impossible to get more work done that night. And she could hear Joan’s voice somewhere in her head, reminding her of the importance of keeping a sleep schedule.

“It’s hard when you’re not here…” she whined to no one in particular, and slumped in the chair. She had to get up. But to go to bed she would have to brush her teeth first. It was just.. insurmountable. She kind of waited for some mean-spirited comment from Erik, but it didn’t come. Huh. Well, thank fuck for small blessings.

Her nails were digging into the skin of her palm, as she tried to will herself to get up. “ _She’s getting worse on the negative spectrum_ ,” the narrator calmly noted. Maria groaned. “Not you.” Of all the annoying shit her brain could throw at her, the narrator was just a fucking pestilence. He was benevolent enough, and quite clinical in his approach, but Maria didn’t need anyone to be telling her she was fucked up.

Suddenly she had no trouble getting up, as the door to medbay abruptly opened. Maria found herself flinging off the chair, determinedly crawling under the table, where she pushed herself flat against the wall. Eyes wide, she stared at the pair of legs and feet that had entered medbay.

-Fuck – flew through her mind. -Way to be fucking professional.-

The figure had clearly seen her, and was contemplating their next move. The person was wearing what appeared to be pyjamas pants. They were likely no threat. Yet she couldn’t bring herself to move a muscle.

“Uhh,” the person said, and suddenly it wasn’t just a person, it was a man. And she knew that voice. “Dr. Nakashima?” McCoy asked, sounding concerned and groggy. “I didn’t mean to startle you.”

Maria closed her eyes and willed him to go away. This could not be happening. She’d done so well. It had been years, since her anxiety and paranoia had landed her in a truly embarrassing predicament like this one.

She wanted to speak, to assure the good doctor that she was fine. Maybe laugh it off. But she just knew that if she opened her mouth right now, all that would result, would be a whimper. Someone was laughing at her. Erik, she reminded herself. She was one of the lucky ones. Her voices were very distinct, and she had always known that they were merely fragments of her imagination. A lot of her patients didn’t have the luxury of that knowledge.

“Are you alright down there?” McCoy asked again.

“Mm,” she managed to say. It felt like she had to push the words through mud. The doctor sighed.

“It’s quite late, huh,” he said conversationally. “Bet ya didn’t expect for anyone to come down here.”

“Mm,” Maria repeated her success.

“D’ya mind if I crouch down?” he asked, and the feet moved a bit, so he was more turned towards the table.

“…..No,” Maria said at last. She wasn’t keen on having the doctor’s judgemental eyes on her, but at the same time she didn’t have a good reason to deny him the right to sit down. A moment later McCoy was on his knees, peeking under the table. She met his eyes quickly, surprised at the warm understanding and… amusement?

“Well this is a once-off,” McCoy said, smiling slightly. “I don’t usually scare our consultants to the point where they hide under tables. Was my interview that hideous?” He still seemed a little amused, but mostly concerned. Maria swallowed.

“I’m sorry,” she managed, and the words were flat, like she’d pushed them under a door on their way out.

“Oh, don’t be,” McCoy said. “I guess it’s kind of a relief to see that you’re human! With the speed you’ve been processing interviews, I’d been starting to think they’d sent us a computer!” He shifted, and sat down on his butt. Now that Maria got a good look at him, she could tell that he wasn’t feeling well. He had dark bags under his eyes, and was pale and shivering. Suddenly Maria felt a lot stronger.

“You’re sick!” she exclaimed, and finally moved from her position pressed against the wall.

“Ahh, it’s nothing that I ain’t used to,” McCoy said, even as he closed his eyes for a few seconds, clearly trying to get a hold of himself.

“You said the migraines were a rare occurrence,” Maria noted clinically, trying to keep the accusatory tone out of her voice.

“Hey hey, you’re hiding under a table, and we’re questioning **_me_**?” McCoy said, gaining some colour in his cheeks. “Who’s to say I lied? It could just so happen, that I was having one now, right after our talk..”

“Quite the coincidence,” Maria noted. Then a thought occurred to her.

“Have you been reading my reports?”

McCoy looked a little surprised at the change of topic.

“Well I.. yeah. Yeah, of course I have.” This time he brought his hand to his head, as he closed his eyes for a bit and breathed heavily.

“I’m sure you’re aware that migraines can be brought on by stress,” she said, and got on all fours so she could crawl out from under the table. “I’d submit that perhaps you’ve been reading about your friends and worrying about them,” she walked on all fours, until she was out in the open again. McCoy was scooting backwards.

“Well! How could I not be!” he said defensively. “You make it all sound so neat, and they’re performing satisfactorily this, and he seems well-adjusted that, but…” 

“But?” Maria asked, not unkindly. She had slipped completely into the role of psychiatrist now, it was a comforting mind-space to be in.

“Well those idiots, they…” McCoy started, then shook his head vigorously.

“..Now wait a minute missus! You’re leading me off topic here! What’s the deal with you hiding under the table in the first place..?”

Maria sighed.

“I’m Psychotic and Anxious Divergent,” she said matter of factly. “Now, you were saying..?”

“You?” McCoy asked, a little wide-eyed. “I suppose I just supposed.. I mean, you are a psychiatrist..”

“And a damn good one at that,” Maria said defiantly. “So let me do my job.”

There was silence for a bit while she studied the man. He really didn’t look good, and she was starting to think that he needed a different kind of doctor.

“You need medicine,” she said finally. “Where do you keep it?”

McCoy shook his head, then closed his eyes again, as if the movement had caused him pain.

“Don’t bother.. I’ll get it myself..” he started to push himself back on his feet. Maria silently stood up and offered him a hand, which he didn’t take.

She knew better than to push her help on someone who wanted to deal with a problem on their own, so she stood silently by as the man made his way over to a cabinet of hypos.

“You could keep some in your quarters,” she said softly, as he prepared the hypospray.

“Nah,” McCoy said before he administered the serum. “I like to make sure taking it doesn’t become a habit.”  He put the empty vial down, and staggered over to one of the biobeds where he finally sat down.

“That’s illogical,” Maria said, walking towards him. “The serum is not dangerous, and there’s no reason to prolong your suffering! Research has shown that suppressing migraines as they develop is ..-“

“Yeah yeah yeah..” McCoy interrupted her. “Look. Don’t you have something better to do than pretending to be our First Officer? I get enough of that on the regular.”

Maria shut up, contemplating her next move.

“Well, I was going to ask you about what you were stressed about. But now I’m somewhat curious why you choose to suffer more than you need to. Are those two connected..?” she thought out loud.

McCoy groaned. “Is it really ethical to be conducting psychoanalysis on a man in pain? Much less one who isn’t your patient?” he asked, and pushed himself further unto the bed.  “Besides, I’m going to sleep soon, this stuff hits hard.”

“Most people who attend therapy are somehow in pain,” Maria walked up to the bed. “But that said, I’m not attempting to subject you to therapy, either.” She crossed her arms.

“Professional curiosity?” McCoy asked.

“More like.. Compassion,” Maria said softly. She silently vowed not to include any new information in her report on the doctor. It just didn’t seem right.

“Fine.” McCoy said, and finally he had pushed himself unto the bed so he was lying down on his back. He closed his eyes. “Let’s hear it, Freud.”

Maria smiled at the archaic reference.

“How does it make you feel when you read about your friends in this context?” she asked mildly.

“… Like I’m invading their privacy,” McCoy spoke quickly. “And like I want to sit them down and hug all of them, the whole crew, even Spock, if he’d let me..” he paused for a bit, but Maria sensed that he wasn’t done talking, so she kept quiet.

“I want .. to fix things.” He admitted. “I don’t want them to feel bad things, ever. And I feel inadequate as their doctor. Because I can’t fix everything.” McCoy opened his eyes. “I don’t know why I’m telling you all this. Is this the secret power of a trained psychiatrist?”

Maria grinned. “It’s probably more like the power of your migraine and the counter-migraine meds, but sure, I take what I can get.” She turned serious.

“..You know, there’s quite a lot of responsibility riding on your shoulders as CMO,” she said it as conversationally as she could, keeping any hint of pity out of her voice. “And add to that, how some of these people are your close friends. I’m not surprised that you stress over it!”

“It’s not just that,” McCoy said. “I don’t like the fact that the higher brass is gonna be reading this.. It doesn’t seem right.”

“Those are the rules,” Maria said matter-of-factly.

“You sound like Spock again.”

“You seem somewhat preoccupied with the First Officer,” Maria countered, narrowing her eyes slightly.

“Me? Preoccupied? With that hobgob..-“ he semed to realize what he was saying, and to who, and restrained himself. “I mean. No I’m not.”

“Okay,” Maria said. “If you say so.”

There was silence for a while. She was starting to wonder if he’d fallen asleep, and her strategy had been in vain.

“… I may be thinking about the Autistic Constellation you’ve designated him with, and PNER,” McCoy then said. “It makes me feel kind of like an asshole.”

Even though McCoy currently had his eyes closed, Maria resisted the urge to lift her eyebrow, feeling somewhat self-conscious about mimicking the half-Vulcan now.

“How so?” she settled on. Nice and open-ended. Fuck, she was too tired for this conversation.

“Well. I’m always making fun of him for acting like a computer and stuff like that. If he’s really autistic wouldn’t that mean I’m being ableist? And also, does that mean I’m part of the prolonged negative exposure pattern…?” he asked softly.

“Look..” Maria said. “Talking as someone who’s seen all of you interact, I don’t think you need to worry. Spock seems to give as good as he gets, and like I wrote in my report, he seems remarkably well-adjusted here..”

She expected McCoy to argue further, and mentally prepared a bunch of arguments, so she was surprised when he went in another direction entirely.

“You know.. There’s so much suffering in the universe.” His voice was almost a whisper, like it had only just occurred to him, and he was afraid that saying it out loud would be the final confirmation. “I’s not just that I feel inadequate now. I want to go back in time and make everything right. Ji-.. Captain kirk should’ve never even been on that damned planet.. I can’t believe anyone would hurt Uhura.. Sulu deserved so much more than he got.. And Yeoman Ross… God, Yeoman Ross….. “ his voice was growing fainter, and he seemed to be jumping between different thoughts. Maria surmised that he would soon be fast asleep.

“So I think of myself and I…” he didn’t say anything for a while. Maria was starting to turn away to collect her padd that had fallen to the floor when she’d been scared earlier.

“..I think that maybe.. Maybe I need to suffer a little more, too..” he finally finished. Maria slowly turned back around. She’d been somewhat expecting this, but she still wasn’t happy to hear it.

“Doctor, that’s not… logical,” she said. Damn, had she been preoccupied with Spock’s case to the point where his mannerisms had actually rubbed off on her? She was a psychiatrist, for fuck’s sake, she of all should know that not everything was rational – that didn’t make it any less real.

She didn’t get a second chance, however, as McCoy’s breathing had evened out into soft snores. He was asleep.

She’d seen this before. It was common for someone less bothered by divergence in a group of friends to feel like they didn’t deserve that status, and all too often it lead to maladaptive divergent behaviour in the person.

She went to pick up the padd where it had fallen, and scrolled back through the ranks until she found the CMO. It was one of the shorter files, as she had been pretty much in agreement with former asessments.

 

 ________________________________________________________________________________

 

## CMO Leonard McCoy

 

### Description:

McCoy has good contact throughout the interview, and appears socially well-adjusted. His history shows that he had some trouble with social adjustment when he was young, which is consistent with Neurodevelopmental Divergence Generalis.

Specifically, McCoy has been diagnosed with fairly severe Sensory Integrative Difference since early childhood. He experiences synaesthesia and sensory overload, which lead to meltdowns in childhood and migraines in adulthood. He scores high on empathy and sensitivity.

He engages in self-stimulatory behaviour.

The subject was diagnosed with Dyslexia upon entering school, I have decided not to retest.

The subject has some anxious traits, worrying sometimes excessively over the safety of the crew, the dangers of space and similar ruminations. However, as he scored very low on avoidance, I do not believe this to be substantial to qualify him for an anxiety divergence.

He scores moderately high on depressive traits, but not particularly high on anything specific, that would be classified as a designation.

### Test results:

Empathy scores – High cognitive and emotional empathy

Anxiety score - moderate

Mood Divergence – moderate

Personality Divergence – non-divergent

 

### Designation:

ND (Neurodevelopmental Divergence) – SID (Sensory Integrative Difference)

LD (Learning Divergence) – DC (Dyslexically Challenged)

 

### Reccommendations:

I suggest that he continue current levels of support for LD-DC and ND-SID.

He might benefit from talk therapy with regards to his anxious beliefs.

 

### Fit for duty:

Yes.

 

 

__________________________________________________________________________

 

Maria put the padd down and looked toward the CMO. The buzzing in her head had grown into a persistent screeching. There had to be a cricket involved, somehow.

She felt like she was about to have the kind of dramatic epiphany one only ever has at three oh clock in the night.

Then she got a closer look of the doctor. A streak of drool had made its way down his cheek. Maria smiled softly, while the oft-repeated words of her partner rung in her head.

“Honey, It’s not that deep.”

**Author's Note:**

> Lol I dunno! It’s not that deep ;)
> 
> For those interested, these are the categories I imagine exist (in no particular order):
> 
> Neurodevelopmental Divergence (ND)  
> Mood Divergence (MD)  
> Reactive Divergence (RD)  
> Psychotic Divergence (PsD)  
> Personality Divergence (PD)  
> Anxious Divergence (AD)  
> Learning Divergence (LD)
> 
> And under each there are a number of fairly specific designations. In that sense I am imagining that the diagnostic manual of the future is both more and less specific than today. In daily use, one would often just refer to the Divergence Category. There also exists “constellations” which are often co-occuring designations. 
> 
> I know there’s also a good argument to be made, that the manuals will in fact develop away from a categorical approach and towards a more dimensional approach. For the purposes of this fic I chose that this wouldn’t be the case, as it would have been near impossible for me to devise such an approach, and even harder for any readers to follow! This way, I could just wing it with specific-sounding designations.  
> I hope someone enjoyed this odd and self-indulgent story… :P Please let me know what you think, it means the world to me! Also, if you'd like to hear more of what I imagine are symptoms of specific designations etc, HMU! My Star Trek tumblr is entertheprize.tumblr.com and my regular tumblr is butwhatistrue.tumblr.com
> 
> [I think Maria's reasons not to diagnose Spock with a Personality Divergence are somewhat clear, but keep in mind that these things often come down to the psychiatrist in question, and this is not to say that she's more correct than those who came before her! I kind of wanted to get across that it's pretty hard to diagnose someone who is both biologically and culturally so different! ]


End file.
